Department of Internal Medicine, Inje University Ilsan Paik Hospital, Goyang, Korea.
Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Korea.
Liver Int. 2019 Jan;39(1):60-69. doi: 10.1111/liv.13930. Epub 2018 Aug 10.
BACKGROUND/AIM: In the era of direct-acting antivirals (DAA), active screening for hidden hepatitis C virus (HCV) infection is important for HCV elimination. This study estimated the cost-effectiveness and health-related outcomes of HCV screening and DAA treatment of a targeted population in Korea, where anti-HCV prevalence was 0.6% in 2015.
A Markov model simulating the natural history of HCV infection was used to examine the cost-effectiveness of two strategies: no screening vs screening and DAA treatment. Screening was performed by integration of the anti-HCV test into the National Health Examination Program. From a healthcare system's perspective, the cost-utility and the impact on HCV-related health events of one-time anti-HCV screening and DAA treatment in Korean population aged 40-65 years was analysed with a lifetime horizon.
The HCV screening and DAA treatment strategy increased quality-adjusted life years (QALY) by 0.0015 at a cost of $11.27 resulting in an incremental cost-effectiveness ratio (ICER) of $7435 per QALY gained compared with no screening. The probability of the screening strategy to be cost-effective was 98.8% at a willingness-to-pay of $27 205. Deterministic sensitivity analyses revealed the ICERs were from $4602 to $12 588 and sensitive to screening costs, discount rates and treatment acceptability. Moreover, it can prevent 32 HCV-related deaths, 19 hepatocellular carcinomas and 15 decompensated cirrhosis per 100 000 screened persons.
A one-time HCV screening and DAA treatment of a Korean population aged 40-65 years would be highly cost-effective, and significantly reduce the HCV-related morbidity and mortality compared with no screening.
背景/目的：在直接作用抗病毒药物（DAA）时代，对隐匿性丙型肝炎病毒（HCV）感染进行主动筛查对于消除 HCV 至关重要。本研究旨在评估韩国一个目标人群 HCV 筛查和 DAA 治疗的成本效益和健康相关结局，该人群 2015 年抗-HCV 流行率为 0.6%。
使用模拟 HCV 感染自然史的 Markov 模型，检验两种策略的成本效益，即不筛查与筛查加 DAA 治疗。通过将抗-HCV 检测纳入国家健康检查计划进行筛查。从医疗保健系统的角度出发，分析了韩国 40-65 岁人群单次抗-HCV 筛查和 DAA 治疗的成本效用，以及对 HCV 相关健康事件的影响，采用终生时间范围。
与不筛查相比，HCV 筛查和 DAA 治疗策略增加了 0.0015 个质量调整生命年（QALY），增量成本效益比（ICER）为每获得一个 QALY 需花费 7435 美元。在支付意愿为 27205 美元的情况下，筛查策略具有 98.8%的成本效益概率。确定性敏感性分析显示，ICERs 在 4602 美元至 12588 美元之间，对筛查成本、贴现率和治疗可接受性敏感。此外，它可以预防每 10 万人筛查中 32 例 HCV 相关死亡、19 例肝细胞癌和 15 例失代偿性肝硬化。
对韩国 40-65 岁人群进行一次性 HCV 筛查和 DAA 治疗具有很高的成本效益，与不筛查相比，可显著降低 HCV 相关发病率和死亡率。
